New osteopathic approach to cervicogenic disorders met Joseph Gill-Lussier DO

Cervicogenic disorders (neck pain, headache, tinnitus, dizziness) represent a frequent reason for consultation. This course aims at deepening knowledge and providing osteopaths with a variety of approaches for patients with complex care trajectories who have already consulted osteopaths and other therapists without results. The literature on chronic neck pain, cervicogenic headaches and cervicogenic dizziness will be presented in order to inform clinicians. The pathophysiology, epidemiology, semiology and differential diagnosis associated with these disorders will be discussed. From a clinical point of view, it will be taught how to apply this knowledge in the field in a preventive, curative, palliative or referencing framework, taking into account the delimited field of action of osteopaths.

THE ADVANCED VOLUMETRIC APPROACH (AVA) is an osteopathic technique developed by Joseph Gill-Lussier, D.O. specifically designed for complex cases. Based on the principles taught by Robert Rousse, D.O., the technique incorporates influences from Becker, Hoover, and Arbuckle to create a unique and effective clinical approach. The AVA method involves establishing a dialogue with the patient’s tissues and engaging the whole person to achieve the normalization of the cervical neurological subunit. The approach also considers the neuromechanical link between the peripheral levers and structural manipulations and their effects on the central nervous system. Moreover, the AVA approach takes into account andragogical, self-efficacy, and biopsychosocial models to guide treatment. This collaborative clinical approach is known to effectively address complex cases found in the clinic, and has helped many patients to achieve better outcomes.

Related articles:

• Letter regarding the article entitled “participation in daily life activities at two months after stroke predicts long-term health-related quality of life” https://www.tandfonline.com/doi/full/10.1080/10749357.2023.2291906
• Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review https://www.mdpi.com/2077-0383/12/5/1884

GENERAL OBJECTIVES of the course

• RAISING THE OSTEOPATH’S AWARENESS OF to the importance in identifying the root causes of the imbalance, headaches, tinnitus, pain and of considering possible comorbidities and interdisciplinary collaboration.
• DEVELOP A CORRECT AND ACCURATE LEXICAL SET
• LEARN THE OSTEOPATHIC ASSESSMENT AND APPROACH of patients with cervicogenic disorders with the Advanced Volumetric Approach.

SPECIFIC OBJECTIVES

• UNDERSTAND the pathology and pathophysiology associated with cervicogenic disorders implicating dizziness, headache, tinnitus and neck pain.
• KNOW the existence of their main dangerous mimics (transient ischemic attack, arrhythmia, stroke, etc.)
• UNDERSTAND the delimited field of action of the osteopath and the importance of referencing in the treatment of the various vestibular, central or vascular pathologies.
• EVALUATE AND USE the Advanced Volumetric Approach, therefore:
• KNOW HOW TO APPROACH proprioceptive cervicogenic dizziness, cervicogenic headaches, cervicogenic tinnitus, and chronic neck pain.
• DEVELOP THE NECESSARY KNOW-HOW AND MENTAL POSTURE in the technical procedure and in the therapeutic contact with the patient.
• ESTABLISH a logical relationship between structures, anxiety and fatigue, and function in the context of cervicogenic disorders.
• KNOW THE KEY STRUCTURES of the different systems and mechanisms to guide relevant and effective intervention in osteopathy in the context of damage to the cervical neurological subunit.

PRESENTATION PLAN:

Each day will take place in 2 parts:

AM THEORETICAL PRESENTATION: Knowledge and Professional Skills

PM THE PRACTICE Know How.

DAY 1

THEORETICAL PRESENTATION

Clinical context from which emerged the Advanced Volumetric Approach.

Review on Cervical Proprioceptive Dizziness

• Consequences on the patients according to the characteristics of the populations affected.
• Fall risk assessment and universal fall precautions.

Osteopathic Constructs: Clinical Approach

• Osteopathy ontology and conceptual considerations: What is osteopathy in 2023?
• So what is the active ingredient?
• What is osteopathic lesion or “somatic dysfunction”?

Know How, Principles and Models in Osteopathy

Basic evaluation triad to promote the conditions for dialogue

Principle of test-correction and correction systems

-Know-how: Tissue dialogue,

-Constructs of functional and structural according to Hoover,

-The spring and barrier concept

-Adaptation

-The different moments of induction

Introduction to embodied Osteopathy

PRACTICE

The tissue framework and liquids: a model of tensegrity

Structural and fluid mass mechanism according to Robert Rousse D.O. and Magoun

Global work: “structural-fluidic”

The Comma Technique

Induction test practice

– Lateral chest compression test

– A/P compression test

– Cephalo caudal compression test

Spiral thoracic volumetric techniques (Variant on post endothoracic fascia, Variant on ant endothoracic fascia, Nancy Côté D.O. variant (“open the book”))

Thoracic normalisation: Mediastinal area

«Care bear» technique (upper and lower limb)

Lateral decompression of the thorax in 3 stages using levers

Lateral shoulder decompression in DD

DAY 2

THEORETICAL PRESENTATION

Review Continuous Cervical Proprioceptive Dizziness…

• Interdisciplinarity
• Red flags, Differential diagnosis-Pathology, semiology and treatments
• Vertigo of central origin (Post concussion syndrome, Psychogenic vertigo, Vestibular migraine, Basilar migraine, Vertebrobasilar insufficiency)
• Functional vertigo (PPPD, cervicogenic dizziness)
• Common benign and dangerous etiologies of vertigo and dizziness – pathophysiology and pathophysiology. -Other differential diagnoses.

PRACTICE: Global work continued…

Spiral work

1-Posterolateral chain (BIT)

2-Work for DM with head flexion. (and eyes)

3-Tx-Lumbar segmental work

Visceral Frame Normalisation

Peri-umbilical- hypogastric

Urogenital gutter

Pubo-vesico-gyneco-sacral recto blade and hypogastric density

Objectives, dialogue, therapeutic approaches

Upper middle and lower posterior unit work.

DAY 3

THEORETICAL PRESENTATION

Review Cervical proprioceptive dizziness continue…

• Interventions

Review of non-specific chronic cervicalgia

• Pathophysiology of chronic pain
• Apprehension-avoidance model
• self-efficacy
• Predictive and interoceptive “embodied” model

Review of headaches of cervical origin

• Etiology
• Diagnostic criteria
• Differential diagnosis
• Treatments

PRACTICE

Cross work of densities and adhesions: “Jesus Christ super star” technique

• In distraction/compression
• prevertebral chain, DM, Vertebral

Work of the anterior cervico-visceral compartment with an inverted lever on the Dura and the prevertebral chain

Work on deep visceral sheath and hyoid mobilization

Test in a-p high cx

Mobilization test and search for the slowing point

Density or adhesion work

1-cervico-colic

2-cranio-cervical,

3-cervico-cranial

Technique of Romeo and Juliet modification of the Technique of Fredérick Sary D.O.

Working of the anterior cervico-visceral compartment with an inverted lever on the DM and the prevertebral chain.

Slow down point and osteopathic lesion

Counterstrain technique in DL Head scapula cx, thx, sup Limb.

DAY 4

 THEORETICAL PRESENTATION:

Presentation of the cranial volumetric concept:

• Cranial and intracranial tensegrity system.
• System of pillars and arches.
• Cavity and cranial compartments.

Bowl Demonstration.

PRACTICE :

Work C0.C1 TMJ. (“cervical trigeminate nucleus”)

Cranial work: AP sphere: compression-decompression, Lateral compartments.

Bilat TMJ cradle technique in distraction,

TMJ technique in compression.

Technique of the cross OM Orbital axis.